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Prophylactic antibiotic treatment of bronchiectasis with azithromycin
  1. G Davies,
  2. R Wilson
  1. Host Defence Unit, Royal Brompton Hospital, London, UK
  1. Correspondence to:
    Dr R Wilson
    Host Defence Unit, Royal Brompton Hospital, Sidney Street, London SW3 6NP, UK; r.wilsonrbh.nthames.nhs.uk

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Once a treatable cause of bronchiectasis such as hypogammaglobulinaemia has been excluded, management largely involves physiotherapy and treatment of infective exacerbations with appropriate antibiotics.1 In a proportion of patients this is not adequate to prevent frequent infective exacerbations. Prophylactic antibiotic treatment can be used to try to prolong the exacerbation free period. This may be administered orally, via a nebuliser, or using a cyclical regimen of intravenous antibiotics. Prophylactic treatment may be problematic due to side effects and development of antibiotic resistance.2 Macrolide antibiotics exhibit immunomodulating properties. Long term, low dose erythromycin has been shown in diffuse panbronchiolitis, a disease with some similarities to idiopathic bronchiectasis, to be effective in controlling chronic suppurative airways disease.3 Recently published research has shown benefits of long term azithromycin treatment in patients with cystic fibrosis.4 These results led us to consider using azithromycin as prophylaxis in patients with non-cystic fibrosis bronchiectasis with frequent infective exacerbations.

Patients attending the outpatients department between February 1999 and April 2002 who fulfilled the following criteria were considered for azithromycin prophylaxis:

  • bronchiectasis defined by CT scan;

  • any causal condition had been treated if possible;

  • general management …

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